Wolverhampton Total Health Limited An NAPC rapid test site for the primary care home model Dr Gillian Pickavance

Primary Care Home 1 - Wolverhampton Total Health Who we are: At the end of 2015 a group of 8 GP practices were successful in their bid to become a test site for the Primary Care Home model of care. Our 8 GP practices based in Wolverhampton comprising of 26 GPs,16 nurses, 8 HCA’s and >100 admin staff are as follows: TUDOR MEDICAL CENTRE DRS KHARWADKAR & MAJI KEATS GROVE SURGERY CAERLEON SURGERY CHURCH STREET SURGERY EAST PARK MEDICAL PRACTICE NEWBRIDGE SURGERY WHITMORE REANS MEDICAL PRACTICE

Four core characteristics of a Primary Care Home The provision of care to a defined, registered population size of 30,000 to 50,000 people A combined focus on personalisation of care with improvements in population health planning, provision and outcomes An integrated, multi-disciplinary workforce, with a strong focus on partnerships spanning primary, community, secondary, third sector, mental health and social care Financial drivers aligned with the health needs of the whole population. 1 2 3 4

The PCH model will deliver multiple benefits in Primary Care The 30-50k population of a PCH, through being the right size to scale and right size to care, brings benefits for the future development of Primary Care: Improved patient care: Enhancing proactive and person centred care by focusing on the needs of the person rather than the needs of the service. Enriching the experience of an individual in a care system with increased satisfaction, particularly in relation to good access to services Increased staff fulfilment: The PCH provides the environment and conditions for workforce development and effective team working, alleviating pressure across the local system and increasing the ability to attract and retain staff. Improved utilisation of locals resources: care teams that do the work take responsibility for a whole population budget for that registered community, redirecting resources from the acute sector where they can be more appropriately invested in primary care Delivers improvements in General Practice: multi-disciplinary teams in primary care will release more time for GPs Helps to stabilise Primary Care: make it easier for local providers to engage with each other and disparate units of Primary Care to coalesce into more robust units

The PCH model has spread to 92 sites so far 5

The PCH model will drive improvements in patient wellbeing, the quality of care, resource utilisation and staff experience PCH rapid test sites are developing the four characteristics of the PCH across their local population health priorities The impact of the PCH model on outcomes is being measured locally and nationally in three case study sites, across 6 domains for those populations Improvements in each area across population of 30,000 – 50,000 will drive delivery of the triple aims of the 5 Year Forward View. The outcome measures used by each PCH site for each domain vary based on their local priorities. The table below provides some examples of those being used by the RTS: 7

The PCH Model is expected to drive improved resource utilisation Resource utilisation benefits will be dependent on local priorities, but could include: Proactive care approach to the health and well being of the local population, reducing demand on local services Increasing patient access to a wider range of provider services, reducing the number of queues in the system and optimising patient flows Removing the need for outpatient attendances, increasing care provision in the right care setting Application of a systematic approach to care of people with long term conditions leading to lower referral rates to hospital Increasing access to key diagnostic tests to enable more completed episodes of care within the PCH Increasing the range and reliability of therapeutic interventions through a PCH on-site ‘care bundle’ approach, reducing prescribing costs Extending roles and responsibilities within the PCH in line with efficient ‘care bundles’ to attract and retain an effective workforce Optimising early discharge of patients admitted by PCH clinicians collaborating with acute care specialists.

Primary Care Home 1 - Wolverhampton Total Health Our organisation:

Wolverhampton Total Health New Models of Care (Wolverhampton) Primary & Acute Care Systems (PACs/VI) is a collaboration between NHS Trusts and GP Practices to meet the needs of registered list(s) of patients. This is an opportunities for trust’s to kick-start primary care expansion but reinforce out of hospital care which could evolve into taking accountability for all health needs of a registered list of patients. Part of Vertical Integration is a greater level of back office support which will care of the business element of General Practice. Multi-speciality Care Provider is a new deal for GP’s as part of the 5 Year Forward View. This would take the shape of being a collaboration of a group practices i.e. federations, networks or single organisation(s). This is not only an opportunity to standardise back office functions and avoid replication but also a way of expanding leadership to include many healthcare professionals. Across the grouping there will be a collaborative approach to service provision whilst there will be a greater convenience for patients shifting the majority of outpatient consultations & ambulatory care out of hospital settings. Vertical Integration (VI) Primary Care Home Alliance / Federation Wolverhampton Total Health 8 practices c49,000 patients (1 further practice to be added) RWT – hospital c30,000 patients Medical Chamber 8-12 practices (provisionally) c32,000 – 76,000 patients 3 practices Primary Care Home 2 8 practices c42,000 patients 3 practices 1 further practice confirming to transfer on 1 Nov ‘16 Medical Chamber or join PCH3 8-10 practices (provisionally) c30,000 – 60,000 patients Discussions are on-going with a number of other practices and yet to be confirmed Emerging Primary Care Home 3 3 practices c30,000 patients Discussions are on-going with a number of other practices and yet to be confirmed Discussions are on-going with a number of other practices and yet to be confirmed A Rapid Test Site for the Primary Care Home Model

Primary Care Homes Challenges Money Working as a team Trust across the teams Involving people outside of the normal practice network Involving and listening to patients Access into secondary care consultants Time Employment issues Indemnity Training

Primary Care Homes Planned Work so far and key objectives: Increasing access to appointments GP appointments can be difficult to get and we will be training reception staff to help patients navigate how to use new members of staff such as pharmacists, advance nurse practitioners and social prescribers We aim to set up HUBS allowing patient access at weekends and evenings for routine and emergency problems. This will involve the practices working together to offer this service. Details are being discussed now based on the NHSE Operational plan to improve access and developing initiatives to meet the 10 high impact actions to release capacity Active signposting; New consultation types; Reduce DNAs; Develop the team; Productive work flows; Personal productivity; Partnership working; Use social prescribing; Support self-care and management; Build QI expertise

Primary Care Homes Meeting the Planned Work so far: Over The Christmas and New Year Period we participated in the CCG scheme to provider extended opening hours for GP practices This was mobilised within two weeks meeting a proposal specification to the pilot looking to offer a HUB model covering the practices from Primary Care Homes 1 and 2 over the three localities in Wolverhampton and offer extended hours core services to their registered patients over the Christmas and New Year period, excluding Christmas and New Year’s Days. Preferably consisting of 1 GP and 1 Nurse offering appointments of 15 minutes per patient for 6 hours per opening day, with a mix of pre-booked and walk-in patient options with 15 minutes administration time at the end of the day and two reception staff. In addition to this we are also participating in a NHSE scheme to offer a HUB model covering the practices from Primary Care Homes 1 and 2 covering the three localities in Wolverhampton and offer extended hours core services to their registered patients over the Christmas and New Year period, excluding Christmas and New Year’s Days and recurring each Saturday until Saturday 25th. February. This has 3 sites one in each of the localities providing services consisting of 1 GP, offering appointments of 15 minutes per patient for 4 hours per opening day, with a mix of pre-booked, bookable on the day and walk-in patient options with no decrease in other appointments and activity and a 15 minutes administration time allowance at the end of the session. The service would therefore provide 72 additional appointments provided from 3 sites Saturday mornings with 2 Receptionists at each site serving a patient population of c100,000 patients from 16 GP practices.

Primary Care Homes Meeting the Planned Work so far evaluation of the CCG scheme The service was offered by 5 practices Newbridge; Whitmore Reans; Church Street; East Park and Caerleon The overall performance with respect the service uptake is summarised as below: In short the service dealt with 465 patients over the 5 days and GP appointment take up was 68% overall.

Primary Care Homes Meeting the Planned Work so far evaluation of the CCG scheme From the patient survey exercise receiving 138 feedback forms from 465 patients a 29.7% return rate.

Primary Care Homes In addition we are changing the way we look at our services Design and develop a new workforce : physicians assistants, pharmacist, ANPs, HCA Use of voluntary services and non NHS partners: Age UK, chatterbox, memory matters, fire service Sharing resources across practices e.g. using GPSI Better use of existing resources by liaising with the better care fund team Coordinating primary and secondary services and blurring the lines between the two.

Primary Care Homes New Clinical Pathways For April 2017 Frailty pathway – Clinical Lead Dr. Pickavance Extended diabetes pathway – Clinical Dr. K. Majid Public Health initiatives – Clinical Lead Dr. Mohindroo On-going for the future Cardiology – Clinical Lead Dr. Roshan Gynaecology – Clinical lead Dr. Kharwadkar Minor ops clinics

Primary Care Homes Workforce and Services – Prescribing / Pharmacy – Andy McGee Mental Health – Dr N. Ram Neuro Rehab - Dr. Kharwadkar Frailty – Dr Pickavance Dermatology – Dr Ravindran Musculosketal – Dr Vij; Dr Asghar Gynaecology – Dr. Kharwadkar; Dr Vij Diabetes – Dr K Majid; Dr N Badar Sexual Health – Dr Pickavance; Dr. Kharwadkar; Dr Vij; Dr Ravindran Cardiology – Dr Roshan

Primary Care Homes What we need to prioritise and deliver:

Test Sites for the Primary Care Home Model Primary Care Homes Comments please Test Sites for the Primary Care Home Model

Want to know more about Primary Care Home? Visit us at www.napc.co.uk/primary-care-home @NAPC_NHS #primarycarehome